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I. PROGRAM RESOURCES
1. Abstinence and Delayed Sexual Initiation for Youth
2. Adolescence Education Newsletter
3. Adolescent Sexual Decision-Making Counseling Protocol
4. Adolescent and Youth Sexual and Reproductive Health: Charting Directions for a Second Generation of Programming
5. Cameroon Youth Program Stimulates Healthy Behavior
6. Early Childbearing in Nigeria: A Continuing Challenge
7. Education is Empowerment: Promoting Goals in Population, Reproductive Health, and Gender
8. Improving Adolescent Health in Bangladesh
9. The Less They Know, the Better: Abstinence-Only HIV/AIDS Programs in Uganda
10. Reaching Vulnerable Girls and Women through a Balanced and Targeted Approach
11. Youth and Contraception: Needs and Challenges
II. RESEARCH SUMMARIES
Contraception and Reproductive Health
1. Nigeria: awareness of cervical cancer
2. Nigeria: characteristics of abortion care seekers
3. Nigeria: contraceptive prevalence among young women
4. Mexico: differences in use of family planning methods by adolescent females
5. Togo: evaluation of ATBEF Youth Centre in Lome
6. Brazil: factors influencing boys' age at first intercourse and condom use
7. Mozambique: obstacles to condom use among secondary school students
8. Uganda: reproductive health behaviour among in-school and out-of-school youth
9. Nigeria: unintended pregnancy among unmarried adolescents and young women
Education
10. Nigeria: cultural and social aspects of HIV/AIDS sex education in secondary schools
11. Nigeria: sexual behaviour of secondary school adolescents
12. Nigeria: unmet need for sexuality education among adolescent girls
High-Risk Behavior
13. India: high-risk behaviour in young men attending sexually transmitted disease clinics
14. Mozambique: sexual experimentation and construction of risk
15. Thailand: youth risk behavior survey
HIV/AIDS
16. South Africa: stigma and HIV/AIDS management
17. South Africa: review of sexual behavior among adolescents
18. Zimbabwe: rising incidence and prevalence of orphanhood
19. Bolivia: street youths the only high-risk group for HIV
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I. PROGRAM RESOURCES
1. Abstinence and Delayed Sexual Initiation for Youth (2004, PDF, 273K)
This two-page Global Health Technical Brief defines abstinence and discusses risks of early sexual début. Lessons learned and program implications include overviews of successful media campaigns and age appropriate messages.
Contact: cauld@usaid.gov
2. Adolescence Education Newsletter (2004, PDF, 1.7MB)
This biannual newsletter about reproductive health education in Asia and the Pacific profiles best practices, regional and national news, research briefs, and Internet resources. Highlights include program recommendations from a youth summit in Sri Lanka, lessons learned from a community-based approach to reproductive health in Myanmar, and inclusion of reproductive health education in Islamic school in Indonesia. Gender responsive education guidelines and suggestions are also included.
Contact: arsh@unescobkk.org
3. Adolescent Sexual Decision-Making Counseling Protocol (2004, PDF, 346K)
The Jamaican Ministry of Health, Youth.now, and UNICEF created a manual to guide counselors in identifying the factors involved in sexual decision-making of youth ages 10-19. Developed from a 2002 study of sexual risk factors of young women, this manual assists adolescent caregivers in exploring topics such as HIV, pregnancy, forced sex, and being in love. Protocol components include an overview of counseling, understanding client knowledge, exploring influences on decision-making, risk identification and reduction, and referral issues.
Contact: webmaster@moh.gov.jm
4. Adolescent and Youth Sexual and Reproductive Health: Charting Directions for a Second Generation of Programming (2005, PDF, 250K)
This workshop report summarizes discussions and presentations from a 2002 meeting between UNFPA and the Population Council. The report is divided into two sections: programming planning, designing, and evaluation and new content and neglected populations. The first category addresses lessoned learned in YSRH programming including evidence-based programming, recognizing the diversity among adolescent experiences, and incorporation of evaluation procedures into program design. The second category focuses on reaching adolescents that were not included previously or adequately in programming. These groups include married youth, refugees and internally displaced adolescents, and the special needs of boys.
Contact: pubinfo@popcouncil.org
5. Cameroon Youth Program Stimulates Healthy Behavior (2004, PDF, 133K)
This research brief profiles the 100% Jeune program's success in raising awareness about HIV, STIs, and pregnancy among youth. Based on follow-up survey data, the program increased knowledge and positive perceptions of condoms. It also showed increased condom usage and decrease in other risky behaviors due to both program activities and external factors. However, HIV risk perception remains an issue.
Contact: nhobby@psi.org
6. Early Childbearing in Nigeria: A Continuing Challenge (2004, PDF, 238K)
This research brief outlines the issue of adolescent childbearing on a regional and national level in Nigeria. Marriage before the age of 20 is common, thus most of these births occur within marriage. The educational, social, and biological costs of young motherhood are also discussed. Recommendations for government policy and improved reproductive health care services are provided.
Contact: buyit@guttmacher.org
7. Education is Empowerment: Promoting Goals in Population, Reproductive Health, and Gender (2004, PDF, 622K)
This report discusses UNFPA's role in education and highlights school-based sexual health interventions. The recommendations include creating an enabling environment for interventions, effective programming, strategic partnership, and conceptual clarification. Case studies include programs from Mongolia, Peru, Uganda, and Yemen.
Contact: martinez@unfpa.org
8. Improving Adolescent Reproductive Health in Bangladesh (2004, PDF, 533K)
This operations research report compares the effectiveness of reproductive health education for out-of-school youth with a program that targets both out-of-school and in-school youth. Both programs were linked to youth-friendly services at health facilities and were compared with a control site. Observed changes include increase of sexual health knowledge, increased support for condom and contraceptive use among unmarried teens, and increased utilization of youth-friendly services.
Contact: frontiers@pcdc.org
9. The Less They Know, the Better: Abstinence-Only HIV/AIDS Programs in Uganda (2005)
Human Rights Watch has released an 80-page report discussing the redirection of HIV/AIDS prevention policy in Uganda. The report found that a new school curriculum excludes information on safer sex, HIV risk in marriage, and provides misleading information. The report details recommendations to the governments of Uganda and the United States as well as other international agencies. It also includes a discussion of whether or not abstinence-only education contributes to a sound HIV prevention program.
Responses to this publication:
Contact: genaos@hrw.org
10. Reaching Vulnerable Girls and Women through a Balanced and Targeted Approach (2005, PDF, 286K)
This two-page brief profiles Population Services International's programs targeting vulnerable women and girls. Uganda's program fighting cross-generational sex includes mass media as well as peer education groups to impart messages about risks, life skills, and cultivating confidence. The HEART media campaign in Zambia works to make abstinence "cool" for youth. A VCT program in Rwanda and commercial sex worker program in Cambodia are also profiled.
Contact: info@psi.org
11. Youth and Contraception: Needs and Challenges (2004, PDF, 200K)
This two-page Global Health Technical Brief outlines young people's need for sexual information, skills to resist the pressure to have sex, and access to contraceptive services to prevent unintended pregnancy. Lessons learned and resources for contraceptive options are included.
Contact: cauld@usaid.gov
II. RESEARCH SUMMARIES
Contraception and Reproductive Health
1. Awareness of cervical cancer, Papanicolaou's smear and its utilization among female undergraduates in Ibadan. Ayinde OA, Omigbodun AO, Ilesanmi AO. Afr J Reprod Health 2004;8(3).
Researchers used self-administered questionnaires to assess the knowledge of 421 undergraduates at the University of Ibadan, probing into their risk factors for neoplastic cervical lesions, awareness of cervical cancer, Papanicolaou's smear, and its utilization. More than three-fourths of respondents reported being sexually active, with sexual debut before the age of 20 occurring in one-half. The mean age at sexual debut was 18.8 years while the modal age was 18 years. Fifty-seven percent had multiple sexual partners, but only 38 percent used condoms. Seventy-one percent were aware of cervical cancer, while only 33 percent were aware of Papanicolaou's smear.
2. Characteristics of abortion care seekers in south-western Nigeria. Oye-Adeniran BA, Adewole IF, Umob AV, et al. Afr J Reprod Health 2004;8(3).
In southwestern Nigeria, researchers obtained information, using a questionnaire, from a total of 1876 women seeking abortion at hospitals. Sixty percent of respondents were between the ages of 15 and 24 years, of which adolescents between the ages of 15 and 19 years constituted 23.7 percent. Fewer married women sought abortions than unmarried women. Students comprised the single largest group. Respondents terminated their pregnancies mainly because they were students or because they did not desire to have children. A little more than one-quarter of abortion care seekers (27.4 percent) reported using contraceptives. These results indicate that young persons, especially in-school adolescents, should be targeted for comprehensive sexuality education.
3. Contraceptive prevalence among young women in Nigeria. Oye-Adeniran BA, Adewole IF, Odeyemi KA, et al. J Obstet Gynaecol 2005;25(2).
This study was carried out to determine the contraceptive prevalence among 832 young women in Nigeria between the ages of 15 and 24 years. Only 11 percent of respondents had ever used contraceptives although 63 percent of them reported sexual intercourse. Contraceptive usage was significantly higher (p < 0.05) among the single sexually active women (38.5 percent) than among the married women (7.7 percent). Only 7.3 percent of respondents are currently using a contraceptive method; condoms and pills were the most widely reported method.
4. Differences in the use of family planning methods by adolescent females according to the education model utilized during pregnancy. Monterrey, Mexico. Nunez Rocha GM, Alanis Alanis Mde J, Alanis Salazar J, et al. Rev Esp Salud Publica 2005;79(1).
This quasi-experimental study compared the use of family planning methods during the immediate postpartum period and two years following childbirth among adolescent females. Sixty-two pregnant adolescents were selected for two intervention groups, the PRECEDE model and the Health Belief model (MCS) groups. Non-parametric statistical tests were employed and 95 percent confidence intervals estimated. In the immediate postpartum, 93 percent of the adolescents in the PRECEDE group accepted the use of a family planning method, similar to the results reported by the MCS group (94.2 percent). Two years later, the PRECEDE strategy had a greater effect that the MCS strategy, with 92 percent of adolescents utilizing a family planning method versus 72 percent.
5. Evaluation of the ATBEF Youth Centre in Lome, Togo. Speizer IS, Kouwonou K, Mullen S, Vignikin E. Afr J Reprod Health 2004;8(3).
In 1998, the Association Togolaise Pour le Bien Etre Familiale launched a youth center in Lome, Togo. To evaluate the center, a three-year panel study was undertaken. Three years after being launched, about 10 percent of surveyed youth had visited the center. Living close to the center, having contact with a peer educator, and owning a television made young people more likely to visit the center. Contraceptive use in the matched sample was associated with knowing a peer educator and visiting the center. Youth center clinical users were younger, less likely to be married, and less likely to have ever been pregnant than clinical users of other sites. This youth center is reported to be meeting its goal of providing services to high-risk youth in Lome.
6. Factors influencing boys' age at first intercourse and condom use in the Shantytowns of Recife, Brazil. Juarez F, LeGrand T. Stud Fam Plann 2005;36(1).
Many adolescent boys are at high risk of acquiring sexually transmitted infections (STIs), including HIV, and of causing unwanted pregnancies; however, advances in mapping their sexual behaviors have been slow. This study uses data recently collected from low-income areas of the city of Recife, Brazil, to study boys' age at first sexual intercourse and factors that hinder their use of condoms. These boys become sexually active at early ages, and despite their general awareness of HIV, they rarely use condoms, especially at ages younger than 15. Family involvement indicates delayed sexual initiation for these boys and an increased use of condoms. Boys who describe themselves as shy with girls have later first intercourse, although the probability of their using condoms does not differ from that of other boys of their age. Higher socioeconomic status leads to earlier sexual activity for boys (in contrast with girls), but also to a greater likelihood of using condoms during first intercourse.
7. Obstacles to condom use among secondary school students in Maputo city, Mozambique. Manuel S. Cult Health Sex 2005;7(3).
Data was collected from high school students in Maputo, Mozambique, to explore how these urban youth perceive their sexual behavior and to identify the factors that prevent them from having safer sex in the context of HIV/AIDS, with special emphasis on the condom use. Using a combination of focus group discussions, interviews, and informal conversations, students reported a major obstacle to the use of condoms was young people's belief that they did not have to use condoms in steady relationships built on love and trust, since these provide them a sense of immunity to infection. Such a perception is reinforced, it is argued, by previous HIV/AIDS campaigns in Mozambique that have advocated the use of condoms only with 'occasional sexual partners.' Students' understandings of pleasure, lack of accurate information, lack of sex education at home and at school, and gender inequalities further contribute to making condom use a difficult issue.
8. Reproductive health behaviour among in-school and out-of-school youth in Kabarole District, Uganda. Ndyanabangi B, Kipp W, Diesfeld H-J. Afr J Reprod Health 2004;8(3).
A total of 300 in-school and 256 out-of-school adolescents were interviewed to determine whether in-school adolescents have sexual behavioral patterns different from those of out-of-school adolescents. Respondents reported significantly greater condom use among in-school than out-of-school adolescents. In-school adolescents claimed fewer sexual partners in the previous year and experienced sexual debut at a later age than out-of-school adolescents. In-school adolescents were more likely to have used modern contraceptives compared to out-of-school adolescents. Out-of-school adolescents require education and services to meet their needs.
9. Unintended pregnancy among unmarried adolescents and young women in Anambra State, southeast Nigeria. Ilika A, Anthony I. Afr J Reprod Health 2004;8(3).
In southeast Nigeria, 136 unmarried teens with unintended pregnancies participated in a study from January 1998 to December 2001. Information was obtained using a semi-structured questionnaire and in-depth interviews. More than 75 percent of the girls had their first sexual intercourse by 19 years, and more than 69 percent reported multiple partners. Almost all of the teens reported having had sex for economic reasons or in exchange for money or gifts. Only 13.5 percent ever used condoms. Ninety-seven percent suffered violence such as beating and verbal abuse from family members because of the pregnancy. Most of the adolescents or young women experienced major stressors as a result of the unwanted pregnancy, including school and job termination, partner's negative attitude, religious sanction, discrimination, and stigmatization.
Education
10. Cultural and social aspects of HIV/AIDS sex education in secondary schools in Nigeria. Oshi DC, Nakalema S, Oshi LL. J Biosoc Sci 2005;37(2).
This qualitative study examined the social and cultural determinants affecting the teaching of HIV/AIDS and sexuality education among secondary school teachers in eastern Nigeria through interviews with 60 secondary school teachers. Researchers supplemented these interviews with five focus group discussions and content analysis of the teachers' lesson plans. Cultural and social pressures can make it difficult for teachers to openly discuss the issues surrounding HIV/AIDS in the classroom. The findings show a high knowledge level of HIV/AIDS preventive measures among teachers, however, teachers are not passing on this knowledge because of cultural and social inhibitions. In addition, teachers have not received adequate training regarding information, education, and communication tactics for HIV/AIDS and sexuality education.
11. Sexual behaviour of secondary school adolescents in Ilesa, Nigeria: implications for the spread of STIs, including HIV/AIDS. Owolabi AT, Onayade AA, Ogunlola IO, et al. J Obstet Gynaecol 2005;25(2).
This research examined the sexual behavior and perception of the risk of HIV/AIDS and other sexually transmitted infections (STIs) among adolescents in Nigerian secondary schools. Quantitative data was collected from 450 senior secondary school students using a multistage sampling technique. In addition, qualitative data was collected by focus group discussion (FGD) with eight groups of 10 randomly selected respondents from four other secondary schools. Sixty-three percent reported sexual intercourse. There was no statistically significant (p > 0.05) difference between the genders [females (52.3 percent) males (77.8 percent)], although males appeared to be more sexually active. The median age at first intercourse was 12 years, with a range of 6-19 years. Many of the respondents had multiple sexual partners. There is poor perception of the risk of sexually transmitted infections (STIs) including that of human immune deficiency virus (HIV). It was concluded that there is a high risk of the spread of STIs, including HIV/AIDS in the study population. In view of the high prevalence of sexual intercourse and the reproductive health problems associated with STIs/HIV/AIDS, it is recommended that a structured family life education (FLE) curriculum should be instituted for all schools starting at an early age.
12. Unmet need for sexuality education among adolescent girls in southwest Nigeria: a qualitative analysis. Omigbodun OO, Omigbodun AO. Afr J Reprod Health 2004;8(3).
This study utilized a qualitative approach to elicit the reproductive health concerns of 75 girls at a Christian summer camp between 7-21 years. The girls anonymously asked questions about various aspects of their sexuality, which were analyzed to identify emergent themes. The different levels of cognitive development were clearly illustrated in the types of questions asked. The older adolescents focused on coping with relationships and demands for sex while early and middle adolescents focused on their feelings, relationships, menstruation, and breast size. Those still in childhood (7-11 years) had many questions about the functions of their bodies. Myths and misconceptions were identified in all age groups. Christian and other religious groups should work with health educators to develop realistic teaching guidelines that focus on the everyday concerns of the youth.
High-Risk Behavior
13. High-risk behaviour in young men attending sexually transmitted disease clinics in Pune, India. Brahme RG, Sahay S, Malhotra-Kohli R, et al. AIDS Care 2005;17(3).
Researchers compared sexual risk factors associated with HIV infection among younger and older men attending two sexually transmitted disease (STD) clinics in Pune, India. Initially, 1872 STD patients were screened for HIV infection; the infection rate was 22 percent. Data on demographics, medical history, and sexual behaviors were collected at baseline. Being divorced or widowed, less educated, living away from the family, having multiple sexual partners, and initiation of sex at an early age were all associated with HIV infection. The risk behaviors in younger men were different compared to older men. Younger men were more likely to report an early age sexual debut, having friends, acquaintances, or commercial sex workers as their regular partners, having premarital sex, and bisexual orientation. Young men were also more educated and reported greater condom use. Similarly high rates of HIV prevalence among younger and older men highlight the need for focused targeted interventions aimed at males based on their ages and risk factors.
14. Intimacy revealed: sexual experimentation and the construction of risk among young people in Mozambique. Karlyn AS. Cult Health Sex 2005;7(3).
Heterosexual transmission is the primary means of HIV infection in Mozambique, with young people identified as a key group for prevention efforts. By focusing on one innovation, the saca cena one-night stand, this paper shows how a subgroup of young people in Maputo has redefined a "risky" sexual practice to include exclusive condom use. As a risk context, the saca cena dictates a set of implicit rules emphasizing anonymity, discretion, verbal and non-verbal cues, and for a set of select innovators, condom use. The saca cena challenges the hegemonic gender roles found among many young people in Maputo of male dominance through sexual conquest and female acquiescence. Instead, the practice allows young people to be both adventurous and responsible. The article demonstrates how sexual identities have been redefined to combine risk reduction with sexual experimentation.
15. Youth risk behavior survey: Bangkok, Thailand. Ruangkanchanasetr S, Plitponkarnpim A, Hetrakul P, Kongsakon R. J Adolesc Health 2005;36(3).
Youth risk behavior survey questionnaires were collected from 2311 adolescents in eight schools, 13 communities, and two Juvenile Home Institutions from January to February 2001 to identify the prevalence of risk behaviors and related risk factors in adolescents in Bangkok, Thailand. The mean age of respondents was 15.5 years, and 59 percent were female. Risk factors included gender, parental marital status, socioeconomic status, family relationship, parental drug addiction, peer group, loneliness, self-esteem, and school performance. Multiple logistic regression was used to identify significant risk factors associated with each risk behavior. Among the 10 percent who reported sexual intercourse, one percent were homosexual, seven percent have never used a condom, and two percent reported pregnancy. Being male was a risk factor for every behavior except depression. Other risk factors included poor self-esteem, poor school performance, and early school leaving. Factors relating to the family included a low socioeconomic status, poor relationships, broken families, and parental substance abuse. Socioenvironmental factors included being in a gang and loneliness. Some risk behaviors started at younger than eight years old. Schools and media were given as the sources of information regarding sex, HIV infection, and substance abuse.
HIV/AIDS
16. "I have an evil child at my house": stigma and HIV/AIDS management in a South African community. Campbell C, Foulis CA, Maimane S, Sibiya Z. Am J Public Health 2005;95(5).
This case study highlights HIV/AIDS management among young people in a South African community (drawing from interviews, focus groups, and fieldworker diaries). Stigma serves as an effective form of "social psychological policing" by punishing those who have breached unequal power relations of gender, generation, and ethnicity. The authors outline an agenda for participatory programs that promote critical thinking about stigma's social roots in conjunction with education and legislation as an integral part of antistigma efforts.
17. HIV/AIDS in South Africa: a review of sexual behavior among adolescents. Hartell CG. Adolescence 2005;40(157).
This paper compiles and reviews available research concerning the sexual behavior of adolescents in South Africa. It offers insight into HIV infection among adolescents and provides an important base for educational interventions aimed at behavior change and reducing further transmission. The most important conclusion is that, despite the research (however limited) that has been done, there has been no significant change in the rate of infection among adolescents in South Africa. A new generation of behavioral interventions, involving both factual knowledge and life skills to promote behavioral risk reduction, is recommended.
18. Rising incidence and prevalence of orphanhood in Manicaland, Zimbabwe, 1998 to 2003. Watts H, Lopman B, Nyamukapa C, Gregson S. AIDS 2005;19(7).
To quantify and describe orphan incidence in Manicaland, eastern Zimbabwe, researchers performed statistical analysis of data on 13,740 and 10,308 children, aged 0-14 years, enumerated in household censuses in four socio-economic strata, 1998-2000 and 2001-2003, and 10,184 children seen in both censuses (74 percent follow-up). Prevalence of all forms of orphanhood increased. The overall rate of losing a parent amongst non-orphans was 27.5 per 1000 person-years (py). Paternal orphan incidence (20.2 per 1000 py) was higher than maternal orphan incidence (9.1 per 1000 py), and maternal orphans lost their fathers at a faster rate than paternal orphans lost their mothers. Paternal and maternal orphan incidence increased with age. Incidence of maternal orphanhood and double orphanhood amongst paternal orphans rose at 20 percent per annum and 71 percent per annum, respectively, 1998-2003, but incidence of paternal orphanhood and double orphanhood amongst maternal orphans remained unchanged. For 82 percent of children with a parent who died, the parent was HIV-positive at baseline. More new paternal and double orphans - but not new maternal orphans - than non-orphans had left their baseline household. Mortality was higher in orphans than non-orphans with the highest death rates observed amongst maternal orphans. Researchers conclude that orphan incidence patterns differ from orphan prevalence patterns and need to be understood if support programs are to assist children during periods of high vulnerability.
19. Street youths are the only high-risk group for HIV in a low-prevalence South American country. Lambert M-L, Torrico F, Billot C, et al. Sex Transm Dis 2005;32(4).
To measure HIV prevalence in various subpopulations in Bolivia, voluntary counseling and testing was offered to homeless street youth, registered and unregistered commercial sex workers, truck drivers, and prisoners. Researchers examined surveillance data of pregnant women and blood donors. Among street youth over 15 years of age, overall HIV prevalence was 3.5 percent, higher among those recruited in the street, lower among those recruited in centers for homeless. In female registered and nonregistered sex workers, prevalence was 0.6 percent (2/334) and 0.5 percent (1/189), respectively, and below 0.3 percent in all other groups. In a low-prevalence setting where intravenous drug use is uncommon, street youth are a threat for the expansion of the HIV epidemic. The authors argue that HIV prevention in this population requires a comprehensive approach to their health and social problems.
